District of workforce shortage
What is a district of workforce shortage?A district of workforce shortage (DWS) is a geographical area in which the local population has less access to Medicare-subsidised medical services when compared to the national average. These areas are identified using the latest Medicare billing statistics, which are updated on an annual basis to account for changes in the composition and geographic distribution of the Australian medical workforce, and the latest residential population estimates as provided by the Australian Bureau of Statistics (ABS).
DWS was introduced in October 2001 and continues to be used to identify areas of Australia that experience the most acute needs for medical services, as evidenced by a comparative shortage of doctors who are billing Medicare.
How are districts of workforce shortage identified?The Department of Health (the Department) is responsible for making DWS determinations. DWS determinations are based on the following information sources:
- the latest Medicare billing statistics, which account for all active Medicare billing and therefore give an accurate indication of the geographic distribution of doctors practising in each medical specialty;
- the latest estimates of the Australian residential population as provided by the ABS; and
- local area boundaries that are defined by the Department with consideration of the ABS’s Australian Statistical Geography Standard (ASGS).
How are districts of workforce shortage for general practice identified?DWS classifications for general practice are provided for geographic areas that are referred to as SA2 boundaries. SA2 boundaries are determined by the ABS as part of the ASGS. The Medicare billing statistics and ABS population data are used to develop a full-time equivalent (FTE) GP-to-population ratio for each SA2 and compared to a national average ratio. DWS determinations that are made as part of this system for general practice are updated annually.
When determining DWS, the Department compares the FTE GP-to-population ratio for each SA2. An SA2 area will be a DWS for general practice if it not classified as an inner metropolitan area by the Department and either:
- has the same or lower FTE GP-to-population ratio than the current national average (i.e. the Medicare billing statistics show that there are more people for every GP within the area); or
- it has a FTE GP-to-population ratio that is within up to 10% of the current national average and the GPs practising privately in that area have a full time workload equivalent to FTE-GP ratio of 1.3 or higher.
How are districts of workforce shortage for the other specialties identified?A similar methodology is used to identify geographical areas that are DWS for the other medical specialties. Such classifications are provided for larger geographical areas, known as SA3s. Like the smaller SA2s, SA3 boundaries are also determined using the ASGS. Larger geographic areas are used when determining DWS for medical specialists because:
- there are substantially fewer medical practitioners engaged in private practice in each of these specialities when compared to general practice; and
- due to lower numbers, these specialists are generally required to service a far greater catchment area than GPs.
The Medicare billing statistics and ABS population data are used to determine the average number of FTE specialists of a type within each SA3 per 100,000 persons residing in the area. The number of FTE specialists per 100,000 persons within each SA3 is then compared with the national average number of specialists per 100,000 persons to identify DWS areas. This methodology applies when making DWS classifications for all specialties other than general practice in relation to all Australian Government programmes that use a DWS definition. DWS determinations that are made as part of this system are updated annually.
When applying the Medicare provider number restrictions under section 19AB of the Health Insurance Act 1973 (the Act), DWS areas for medical specialties other than general practice are defined as follows:
- a SA3 that is classified as outer regional (RA3), remote (RA4) or very remote (RA5) under the ASGS; or
- a SA3 that is classified as a major city (RA1) or inner regional area (RA2) under the ASGS that has a lower FTE specialist per 100,000 persons ratio than the current national average.
It should be noted that for some medical specialities the average number of FTE equivalent specialists is not applied, due to the low number of specialists across Australia. In these instances, these specialties are considered to be in acute shortage, and all areas of Australia are currently considered to be DWS for the purpose of applying the section 19AB restrictions to doctors practising in these specialist fields.
Further AdviceQuestions relating to the use of DWS determinations when applying the Medicare provider number restrictions of section 19AB can be directed to 19AB@health.gov.au.
Questions relating to the use of DWS determinations for the purpose of determining eligible locations for the purpose of the Bonded Medical Placements Scheme can be directed to: BMPScheme@health.gov.au